Individual Membership Form

1
Payment

At the end of this form, you will be prompted to a PayPal link. This link will allow you to pay for your organizations membership online. If you do not wish to pay online, please contact our Executive Director at jen@wheelchairsportsalberta.com or by phone at 780-427-8699.

Once your payment has been sent, we will send your application for approval by our Board of Directors. You will receive a confirmation email from us regarding your application and if it was successful. Before you receive your confirmation email, you are not considered a member under WSA bylaws. For a complete description of our Bylaws, please go to www.wheelchairsportsalberta.com.
2
Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Please enter a valid phone number.
5
Date of Birth * This field is required.
Date
Year
Month
Day
6
Age* This field is required.
7
Please select the sport(s) you will be participating in* This field is required.
Wheelchair Athletics
Wheelchair Tennis
Wheelchair Rugby
Wheelchair Basketball
Sledge Hockey
8
Sport Classification or Sport LevelIf applicable*
9
Club Name (if applicable)If applicable*
10
Photo Release FormBy checking off the following, on the behalf of yourself and your organization, you consent to:
The right for Wheelchair Sports Alberta to use any images resulting from photography and/or video filming for online and/or print publications.
Understanding that my organizations information will be stored in the Wheelchair Sports Alberta database, and this aggregated data may be used for research and statistical purposes.
Wheelchair Sports Alberta's ability to contact me regarding upcoming events. Wheelchair Sports Alberta will use personal information for the sole purpose of event programming, and contact, and will not release or sell personal information to any other sources without my consent.
To receiving the Wheelchair Sports Alberta e-Newsletter
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Freedom of Information and Protection of Privacy Act* This field is required.This information is being collected under section 33(c) of the Freedom of Information and Protection of Privacy Act and will be protected under the provisions of the Act. This information will be used internally to process your membership. Should you have any questions about the collection of this information, you may contact the WSA Executive Director, 11759 Groat Road Edmonton, AB, T5M 3K6 or via telephone at 780-427-8699. Website link to Alberta FOIP Act: http://www.servicealberta.ca/foip/legislation/foip-act.cfm
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Individual Membership
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ORDER SUMMARY
Total costCAD
Individual MembershipIf you do not wish to pay online, contact our Executive Director by e-mail or by phone at 780-427-8699.
$25.00CAD+Edit
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Total cost $0.00CAD
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